Cosmesis from the patient's and the doctor's view

Area of Science:

• Oncology
• Radiation Oncology
• Medical Imaging and Imaging-Related Interventions

Background:

• Assessing long-term cosmetic outcomes after breast cancer treatment is crucial for patient quality of life.
• Patient-reported outcomes (PROs) offer a unique perspective on treatment success beyond clinical evaluation.
• Understanding factors influencing cosmetic satisfaction is vital for improving patient care and treatment planning.

Purpose of the Study:

• To compare patient-reported cosmesis with physician appraisal following breast conserving surgery and radiotherapy.
• To identify key factors influencing patient and physician judgments of cosmetic outcomes.
• To evaluate a patient questionnaire designed to screen for normal tissue reactions and assess cosmesis.

Main Methods:

• A cohort of 287 patients with unilateral breast carcinoma, treated with lumpectomy and radiotherapy, were assessed after a median follow-up of 8 years.
• Patients completed a questionnaire rating satisfaction with cosmesis, overall appearance, and specific breast changes.
• Physicians evaluated cosmesis and late radiation effects using the LENT/SOMA scale.

Main Results:

• A majority of patients (161/287) reported satisfying or acceptable cosmesis, while physicians rated outcomes less favorably.
• Highly visible scars were the most significant factor for patients reporting poor cosmesis.
• Physicians identified severe fibrosis as a primary concern, with a modest correlation (Cohen's kappa 0.29) between patient and physician ratings.

Conclusions:

• Patient satisfaction with breast cosmesis is generally higher than physician assessments and influenced by non-radiation-related factors.
• A patient questionnaire demonstrated potential utility in detecting severe fibrosis, a key indicator for physicians.
• Subjective patient perception plays a significant role in long-term cosmetic outcomes after breast radiotherapy.